Case Report

By Dr. Ping Pisal , Prof. Tae-Hee Kim , Prof. Hae-hyeog Lee , Prof. Wooseok Lee , Dr. Soo-ho Chung
Corresponding Author Prof. Tae-Hee Kim
Soonchunhyang University Bucheon, 1174, Jungdong Wonmigu Bucheon Si Gyeonggido - Republic of Korea 420-767
Submitting Author Prof. Tae-Hee Kim
Other Authors Dr. Ping Pisal
Department of Obstetrics and Gynecology, - Cambodia

Prof. Hae-hyeog Lee
Department of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Soonchunhyang University Bucheon Hospital, n1174 Jung-1-dong, Wonmi-gu, Bucheon-si, Gyunggi-don - Korea, South 424-767

Prof. Wooseok Lee
Department of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Soonchunhyang University Bucheon Hospital, n1174 Jung-1-dong, Wonmi-gu, Bucheon-si, Gyunggi-don - Korea, South 420-767

Dr. Soo-ho Chung
Department of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Soonchunhyang University Bucheon Hospital, n1174 Jung-1-dong, Wonmi-gu, Bucheon-si, Gyunggi-don - Korea, South 420-767


Premature ovarian failure, Menopause, Complication, Uterine artery embolization

Pisal P, Kim T, Lee H, Lee W, Chung S. Premature Ovarian Failure After Uterine Artery Embolization. WebmedCentral OBSTETRICS AND GYNAECOLOGY 2012;3(4):WMC003269
doi: 10.9754/journal.wmc.2012.003269

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submitted on: 19 Apr 2012 05:10:44 AM GMT
Published on: 19 Apr 2012 04:45:43 PM GMT


Uterine artery embolization (UAE) is popular in some countries for management of postpartum hemorrhage, uterine myoma, and adenomyosis. However, avoidance of complications is important to preserve the uterus. The most serious complication is premature ovarian failure. UAE is advantageous for preserving the uterus for fertility; however, premature ovarian failure negates this advantage by causing infertility. We report two cases of premature ovarian failure after UAE. Our cases provide guidance for gynecologists who perform UAE. The first patient, aged 42 years, was para 1-0-0-1 and did not have a significant family history. She complained of metromenorrhagia, but she wanted to preserve her uterus for fertility. We performed a bilateral UAE. After 4 months, she complained of amenorrhea. She was diagnosed with premature ovarian failure by checking follicle stimulating hormone (FSH). The second patient, aged 40 years, had infertility from uterine myoma, endometriosis, and adenomyosis. She had undergone UAE and in vitro fertilization (IVF) 6 years earlier. After IVF, she became pregnant and was admitted from 26 weeks to 29 weeks for preeclampsia and preterm labor. After delivery, she had postpartum hemorrhage, and repeat UAE was performed. Two years later, she complained of hot flashes and amenorrhea. She was diagnosed with premature ovarian failure.


Uterine artery embolization (UAE) has emerged as a safe, effective, and durable alternative to surgery for treating uterine fibroids (1,2), However, premature ovarian failure has been described as one possible complication, with reported rates ranging from 3% to 5% in patients aged.
This complication is thought to occur because of non-target ovarian embolization via the utero-ovarian collaterals, causing hypoxic ovarian damage and loss of ovarian follicles (4–6). It remains unknown, however, whether this is a sporadic event or whether there is a generalized impact of UAE on ovarian function that is more likely to be apparent in perimenopausal women (>45 years old), who have already-diminished ovarian reserve. For younger women, however, ovarian damage might occur that does not result in sudden ovarian failure but that might compromise subsequent ovarian function and even advance the onset of menopause (5,6).
The available data regarding the impact of UAE on the long-term functioning of the ovaries are relatively few and inconsistent (6–7). This is an important issue because earlier menopause is associated with long-term health risks such as cardiovascular disease and osteoporosis (8).
The aim of the present cases was to determine whether women aged.

Case reports

Case 1

A 42-year-old woman arrived at the emergency room with vaginal bleeding and menorrhagia. The patient was para 1-0-0-1 and did not have a significant family history. The following laboratory results were reported: white blood cell count (WBC) 17.35 × 103/µl; hemoglobin (Hb)/ hematocrit (Hct), 7.4 g/dl/20.8%; platelets (PLT), 191 × 103/µl.

Due to menorrhagia, the patient had undergone insertion of an intrauterine device (IUD) at a local clinic. Metromenorrhagia occurred, and she complained of dizziness. She was diagnosed with uterine myoma. Her menstrual flow filled as much as one pad per hour, and she came to the emergency room.

Her symptoms were dizziness, with abdominal pain. Pelvic examination revealed a hard palpable mass and tenderness. Computed tomography revealed a 100 × 98-mm uterine myoma (Figure 1). After transfusion, right femoral artery anesthetic puncture, and application of a cobra catheter, both a uterine artery angiography micro-guide wire and a catheter were applied, and selective pelvic angiography with Gel-foam was carried out. After 4 months, the patient complained of amenorrhea. Ultrasonography revealed a 6 × 5-cm decreasing myoma. A pregnancy test was negative; follicle stimulating hormone (FSH) and estradiol were 34.2 mIU/mL and less than 10 pg/mL, respectively. Menopausal hormone therapy (MHT) was started.

Case 2

This 40-year-old para 1-0-0-1 woman suffered from hot flashes and amenorrhea. Her FSH and β-hCG test results were 95 mIU/mL and negative, respectively. She was diagnosed with infertility with uterine myoma, adenomyosis, and endometriosis in the right ovary. Mixed Gel-foam and antibiotics were injected at both uterine artery ascending branches.

At post-embolization follow-up angiography, the cervical branch was saved, and both uterine arteries were completely occluded. She became pregnant by in vitro fertilization (IVF) 1 year later. She was admitted for preeclampsia, preterm labor, and severe anemia.

A primary cesarean section was performed at 29+6 weeks. She delivered a male 1,080-g newborn. The Apgar was 7/8, hemoglobin was 7.7 g/dL, and proteinuria was detected. Postpartum hemorrhage occurred. The uterine artery was selected by angiography, both the uterine body and fundus were stained, and via nonuterine arterial collaterals, some parts of the uterine body were also stained. MHT was started.


The patients presented with an increase in FSH values after UAE, suggesting ovarian failure. Changes in hormonal markers after UAE indicated impaired ovarian reserve, as indicated by an increase in FSH levels (6). Complications of UAE include infectious disease, deep vein thrombosis, malignant leiomyosarcoma, ovarian dysfunction, uterine necrosis, urinary tract infection, and hematoma (9). The percentage of patients (>45 years) with premature ovarian failure was higher after UAE because of a higher prevalence of uterine-ovarian anastomosis (9). Premature ovarian failure is thought to reflect the initial cohort of ovarian follicles and the rate of follicle depletion with age (10). If this is so, factors that may directly or indirectly damage the follicular pool may affect the timing of menopause by decreasing ovarian perfusion. UAE has been hypothesized to impair ovarian reserve, which could result in earlier menopause, as described in women who undergo hysterectomy with ovarian conservation (11).
Some studies have suggested loss of ovarian reserve in patients of all ages (6, 12), and others have reported no adverse effects, especially in younger patients (13–14).
The polyvinyl alcohol (PVA) particle size is also a risk factor for ovarian failure. The ideal particle size of PVA has not been established, but current opinion is that the particles should not be550 μm, as they can accidentally obliterate non-target vessels (8,11,12). Magnetic resonance angiography has been helpful in predicting early menopause in cases of uterine myoma because the presence of ovarian collateral vessels to the uterine myoma increases the risk of premature ovarian failure or early menopause (9).
Performance of UAE twice in the same woman may be a risk factor for premature ovarian failure, such as in our patient. Early menopause is a rare complication of UAE but should be discussed in advance with patients.


Please accept our sincerest appreciation for a medical crops' director Shin, Won-Han, the chairman of the board of Soonchunhyang University Suh, Kyo-Il,  the director of a hospital Hwang, Kyung-Ho, a pastor Yun, Dae-Young, a librarian Jung, Eun-Ae who lead us with unsparing guidance and encouragement until this paper is completed.


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Source(s) of Funding

This work was supported in part by the Soonchunhyang University Research Fund.

Competing Interests

The authors did not report any potential conflicts of interest.


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